Author + information
- Received March 28, 2010
- Revision received August 18, 2010
- Accepted August 30, 2010
- Published online December 1, 2010.
- Matthew E. Wiisanen, MD,
- Ahmed Abdel-Latif, MD, MSPH,
- Debabrata Mukherjee, MD and
- Khaled M. Ziada, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Khaled M. Ziada, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, 326 CT Wethington Building, Lexington, Kentucky 40536-0200
Objectives We sought to review the published data and perform a meta-analysis to reach robust conclusions in the comparison between bare-metal stents (BMS) and drug-eluting stents (DES) in saphenous vein graft (SVG) percutaneous coronary interventions (PCIs).
Background Drug-eluting stents are superior to BMS in reducing major adverse cardiac events (MACE) after PCI in native coronary arteries. However, studies comparing BMS with DES in PCI of SVG have had mixed results, probably due to smaller numbers and the nonrandomized nature of most of them.
Methods The published reports search identified 4 randomized controlled trials and 19 cohort studies comparing BMS with DES in SVG interventions. Clinical end point data were abstracted and analyzed in aggregate and in subgroup analyses with random-effects model.
Results Patients receiving DES had a lower risk of mortality (odds ratio [OR]: 0.75; confidence interval [CI]: 0.59 to 0.96), target lesion revascularization (TLR) (OR: 0.57; CI: 0.40 to 0.82), target vessel revascularization (TVR) (OR: 0.56; CI: 0.40 to 0.77), and MACE (OR: 0.61; CI: 0.42 to 0.79). Drug-eluting stent use resulted in a significant absolute risk reduction in TLR (−0.07; CI: −0.11 to −0.03), TVR (−0.10; CI: −0.15 to −0.05), and MACE (−0.12; CI: −0.18 to −0.06). There was no significant difference between the groups in recurrent myocardial infarction (OR: 0.99; CI: 0.65 to 1.51) or stent thrombosis (OR: 0.78; CI: 0.40 to 1.52).
Conclusions In this meta-analysis comparing DES with BMS use in PCI of SVG lesions, DES use was associated with improved mortality, MACE, TLR, and TVR. There was no evidence of increased risk of myocardial infarction or stent thrombosis.
- bare-metal stent(s)
- drug-eluting stent(s)
- percutaneous coronary intervention
- saphenous vein graft
Michael Kutcher, MD, served as Guest Editor for this paper. All authors have reported that they have no relationships to disclose.
- Received March 28, 2010.
- Revision received August 18, 2010.
- Accepted August 30, 2010.
- American College of Cardiology Foundation